=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902871437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARON L GORNISH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2006
-----------------------------------------------------
Last Update Date | 02/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 MONMOUTH RD
-----------------------------------------------------
City | OAKHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07755-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-531-5445
-----------------------------------------------------
Fax | 732-531-1776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 MONMOUTH RD
-----------------------------------------------------
City | OAKHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07755-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-531-5445
-----------------------------------------------------
Fax | 732-531-1776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 25MA05099100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------